CMS/EIP Fiscal Report Center: 09
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 119 256.000000 9523.2000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 163 426.000000 15847.2000 37.2000
Subtotal (Total Children Is Unduplicated) 167 682.000000 25370.4000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 13.000000 975.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 10 14.000000 777.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 76 128.500000 9637.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 60 102.500000 7687.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 37 66.500000 4987.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 109 177.000000 9823.5000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 38.500000 2887.5000 75.0000
Subtotal (Total Children Is Unduplicated) 157 547.500000 37338.0000 68.1973
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EI Services,Class #03
INTR-T1013-INTERPRETER 12 44.000000 2200.0000 50.0000
Subtotal (Total Children Is Unduplicated) 12 44.000000 2200.0000 50.0000
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Total 1273.500000 64908.4000 50.9685
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Number of Children (Unduplicated) With at Least One Service 169
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Center 09
Flag Claims Units Chgs Paid
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R 10 13.250000 492.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 151 239.250000 11199.1500 0.0000
P 330 437.000000 20618.9500 20618.9500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 102 122.000000 6848.8500 0.0000
T 186 234.750000 10775.7000 10775.7000
72 121.750000 7343.1000 0.0000
Other 56 105.500000 7629.7500 0.0000
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Total 907 1273.500000 64908.4000 31394.6500